Cost-cutting at patients' expense: The inherent deprivation of
statist health care
By Edmund Daleford
web posted September 23, 2002
A September 20, 2002, Associated Press report revealed to me
a constantly exacerbated frustration felt by Portuguese drug
companies, the government's regulation on whom is a step
beyond that of the United States in the direction of "universal"
taxpayer-funded health care. It is a brief post, but it has
nevertheless sparked a realization at which I could only speculate
earlier.
"Drug companies in Portugal, angered by a new law which
encourages doctors to prescribe generic medicines instead of
more expensive branded drugs, say they intend to call in a debt
of about 525 million euros (US$511 million) run up by the
government. The national pharmaceutical industry association
Apifarma said its members plan to demand immediate payment
of the debt accumulated by public hospitals up to the end of last
year, a newspaper report said Wednesday. Apifarma threatened
to cut the supply of nonessential medicines to hospitals if the
payment is not made, daily Publico said. The health ministry has
said it plans to pay the debt by Oct. 12. The ministry says it
needs to save money to keep the debt-ridden national health
service in operation. Generic medicines will bring savings of
about 60 million euros (US$58 million) a year, it says." (http:
//story.news.yahoo.com/news?tmpl=story&u=
/ap/20020918/ap_wo_en_po/portugal_generic_medicines_1)
Apifarma and fellow companies possess good reason to present
such grievances. A national health care service, one which
proposes to employ "need" as the standard for receiving
treatment instead of the patients' willingness and ability to pay
cannot be recompensed for the amount it spends on "curing" the
homeless, the retarded, and the otherwise incapacitated. The
latter are, simply put, lacking in resources to reward the doctors
who had prolonged their lives and health. Thus, the diligent
medical professionals are unable to receive their promised
salaries, not because of slacking off on the job (which would
have been the case in a laissez-faire capitalist society), but
because they work well, but have no choice of whom to work
for.
Naturally in such a system, the doctors, the pharmaceutical
companies, the researchers, the deliverers are all forced into
literal slavery, working for nothing to sustain a bum due to an
arbitrary classification of the latter as "needy". The government's
debt to them accumulates with every coming pay day, upon
which some of the brightest men in the country of Portugal,
having had to undergo years if not decades of training for an
intricate job, go home hungry, for they have nothing to obtain
from an intoxicated ruffian or a thug on rehabilitation. It is about
time they complained and refused to grant their oppressors the
sanction of the victim by continuing to grant "free" health care.
Of course, as the all-mighty state in Portugal seeks to retain its
stranglehold on the medical market, it seeks to coax the
producers into continuing to surrender their services. It has
chosen to alleviate debt not by liberalizing the markets and
granting doctors and pharmaceuticals the choice of customers,
but by... diminishing the quality of products provided! In a free
market, both brand names and generic items are available, and it
is the patient's decision whether he wishes to expend a greater
sum for a more credible and perhaps more efficient drug or
stock up on his finances while considering a generic medicine
worth trying on a minor ailment. The doctor, as he seeks
payment from the patient in return from providing the best advice
and widest choice range available (so as to satisfy the consumer
and perhaps cause the latter to employ him in regard to future
medical issues). But in Portugal, even the affluent upper-middle
classes, with more than enough money to purchase quality brand
name drugs, would be forced to prescribe to more uncertain and
perhaps less effective treatments. In the slave mentality of
altruism, which is precisely the calculus embraced by the
Portuguese government, perpetuation is achieved only through
sacrifice on behalf of the servant (of his time and effort) and on
behalf of the recipient (of the quality of services he receives).
Moreover, in a laissez-faire capitalist system, there would have
existed no need for socialized health care aimed at a needy,
penniless underclass. Government minimum wage regulations had
for over seventy years in the United States and a century in
Europe barred young beginners from employment due to
insufficiency of skills. This phenomenon, dubbed institutional
unemployment by Ludwig von Mises, took its toll on every
subsequent generation as well as firmly rooted the children of the
original unemployed in a culture of indolence (that of the
ghettoes, now spreading like a plague to the middle classes and
polluting them with a similar mindset) and created the need for an
ever-amounting number of social services-welfare for those
unable to work, social security for those unable to fund their
retirement, Medicare or outright nationalization of health care for
those who have been coerced out of the opportunity to pay their
doctors.
The obvious solution for the Portuguese government and for that
of the United States (as the hypocritical nationalization advocate,
Otto von Bismarck, once said; "Only a fool learns from his own
mistakes.") is to dissociate themselves from medicine! Along with
that, they should abolish wage regulations, terminate
redistribution campaigns, and scram out of economics altogether.
The poor and unemployed will be able to find work and pay
doctors for their health care needs. The doctors will be able to
expand their operations and refine their techniques due to a
massive inpouring of customers and much longed-for money.
Products of every degree of cost and efficiency will be available
to anyone capable of paying for them, and doctors will no longer
be forbidden to advise their patients what is best for their health.
Pharmaceutical researchers will be thrilled to earn their wages on
time and realize that the amount thereof depends on the quality of
their explorations and resulting medicines.
Apifarma and its fellow companies should not satisfy themselves
with a mere repayment of debts, government appeasement for
their virtual slavery. They should, like Dr. Hendricks in Atlas
Shrugged, withdraw all their services from a corrupt government
behemoth until the absolute and irreversible liberalization of
Portuguese markets.
Edmund Daleford is a freelance writer and Vice Editor-in-Chief
of The Rational Argumentator, an online publication championing
the Western principles of reason, rights, and progress, to be
found at
http://www.geocities.com/rationalargumentator/index.html. He is
also a member of the Objective Medicine Group, a philosophical
forum devoted to defending the endeavors of diligent doctors
against state controls and oppression, whose site can be
accessed at http://www.objectivemedicine.org. Mr. Daleford can
be contacted at rationalargumentator@yahoo.com.
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